Care Manager, Telephonic Nurse

This is a fully remote position, open to applicants in United States.

📋 Description

• Provide thorough and holistic case management for the Special Populations program across the entire continuum of care.

• Implement specialized case management interventions utilizing suitable care sites and levels of care.

• Aim to prevent or reduce hospital readmissions.

• Encourage the appropriate use of alternative funding sources.

• Improve care coordination and minimize fragmentation of clinical services.

• Act as the main point of contact for beneficiaries in the Special Populations Program regarding clinical-spectrum activities.

• Collaborate and coordinate with Care Management programs, Military Treatment Facility personnel, physicians, and providers.

• Ensure that fully integrated care plans cater to all beneficiary needs and conditions.

• Report directly to a Manager of Care Management.

⛳️ Requirements

• U.S. citizenship is mandatory.

• Must successfully obtain interim approval for government security clearance (NBIS - National Background Investigation Services).

• Candidates residing in Puerto Rico are not eligible for hire.

• Possession of an active RN license in the state of employment is required.

• Must be able to achieve CCM certification within one year of hiring.

• A minimum of 2 years of case management experience is necessary.

• At least 3 years of clinical RN or managed care RN experience is required.

• Must be able to work an 8-hour shift from Monday to Friday, between 8:00 a.m. and 6:00 p.m. EST.

• Mandatory training for the first 4 weeks will be conducted from 8:00 a.m. to 5:00 p.m. EST.

• A minimum internet speed of 25 Mbps download and 10 Mbps upload is essential.

• A dedicated, interruption-free workspace is needed to safeguard member PHI/HIPAA information.

• Preferred qualifications include a Bachelor's degree in nursing.

• Preferred: Experience with TRICARE.

• Preferred: Familiarity with MCG.

• Preferred: Current CCM certification.

🏝️ Benefits

• Bonus incentive plan based on individual and/or company performance.

• Comprehensive medical, dental, and vision coverage.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance benefits.

• Internet expense reimbursement for associates working from home in California, Illinois, Montana, or South Dakota.

• Telephone equipment provided by Humana.

• Flexible remote work arrangement.

• Occasional travel to Humana offices for training or meetings.